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The CDC's New 'Best Estimate' Implies a COVID-19 Infection Fatality Rate Below 0.3%


According to the Centers for Disease Control and Prevention (CDC), the current "best estimate" for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it—far lower than the infection fatality rates (IFRs) assumed by the alarming projections that drove the initial government response to the epidemic, including broad business closure and stay-at-home orders.

The CDC offers the new estimates in its "COVID-19 Pandemic Planning Scenarios," which are meant to guide hospital administrators in "assessing resource needs" and help policy makers "evaluate the potential effects of different community mitigation strategies." It says "the planning scenarios are being used by mathematical modelers throughout the Federal government."

The CDC's five scenarios include one based on "a current best estimate about viral transmission and disease severity in the United States." That scenario assumes a "basic reproduction number" of 2.5, meaning the average carrier can be expected to infect that number of people in a population with no immunity. It assumes an overall symptomatic case fatality rate (CFR) of 0.4 percent, falling to 0.05 percent among people younger than 50 and rising to 1.3 percent among people 65 and older. For people in the middle (ages 50–64), the estimated CFR is 0.2 percent.

That "best estimate" scenario also assumes that 35 percent of infections are asymptomatic, meaning the total number of infections is more than 50 percent larger than the number of symptomatic cases. It therefore implies that the IFR is between 0.2 percent and 0.3 percent. By contrast, the projections that the CDC made in March, which predicted that as many as 1.7 million Americans could die from COVID-19 without intervention, assumed an IFR of 0.8 percent. Around the same time, researchers at Imperial College produced a worst-case scenario in which 2.2 million Americans died, based on an IFR of 0.9 percent.

Such projections had a profound impact on policy makers in the United States and around the world. At the end of March, President Donald Trump, who has alternated between minimizing and exaggerating the threat posed by COVID-19, warned that the United States could see "up to 2.2 million deaths and maybe even beyond that" without aggressive control measures, including lockdowns.

One glaring problem with those worst-case scenarios was the counterfactual assumption that people would carry on as usual in the face of the pandemic—that they would not take voluntary precautions such as avoiding crowds, minimizing social contact, working from home, wearing masks, and paying extra attention to hygiene. The Imperial College projection was based on "the (unlikely) absence of any control measures or spontaneous changes in individual behaviour." Similarly, the projection of as many as 2.2 million deaths in the United States cited by the White House was based on "no intervention"—not just no lockdowns, but no response of any kind.

Another problem with those projections, assuming that the CDC's current "best estimate" is in the right ballpark, was that the IFRs they assumed were far too high. The difference between an IFR of 0.8 to 0.9 percent and an IFR of 0.2 to 0.3 percent, even in the completely unrealistic worst-case scenarios, is the difference between millions and hundreds of thousands of deaths—still a grim outcome, but not nearly as bad as the horrifying projections cited by politicians to justify the sweeping restrictions they imposed.

"The parameter values in each scenario will be updated and augmented over time, as we learn more about the epidemiology of COVID-19," the CDC cautions. "New data on COVID-19 is available daily; information about its biological and epidemiological characteristics remain[s] limited, and uncertainty remains around nearly all parameter values." But the CDC's current best estimates are surely better grounded than the numbers it was using two months ago.

A recent review of 13 studies that calculated IFRs in various countries found a wide range of estimates, from 0.05 percent in Iceland to 1.3 percent in Northern Italy and among the passengers and crew of the Diamond Princess cruise ship. This month Stanford epidemiologist John Ioannidis, who has long been skeptical of high IFR estimates for COVID-19, looked specifically at published studies that sought to estimate the prevalence of infection by testing people for antibodies to the virus that causes the disease. He found that the IFRs implied by 12 studies ranged from 0.02 percent to 0.4 percent. My colleague Ron Bailey last week noted several recent antibody studies that implied considerably higher IFRs, ranging from 0.6 percent in Norway to more than 1 percent in Spain.

Methodological issues, including sample bias and the accuracy of the antibody tests, probably explain some of this variation. But it is also likely that actual IFRs vary from one place to another, both internationally and within countries. "It should be appreciated that IFR is not a fixed physical constant," Ioannidis writes, "and it can vary substantially across locations, depending on the population structure, the case-mix of infected and deceased individuals and other, local factors."

One important factor is the percentage of infections among people with serious preexisting medical conditions, who are especially likely to die from COVID-19. "The majority of deaths in most of the hard hit European countries have happened in nursing homes, and a large proportion of deaths in the US also seem to follow
this pattern," Ioannidis notes. "Locations with high burdens of nursing home deaths may have high IFR estimates, but the IFR would still be very low among non-elderly, non-debilitated people."

That factor is one plausible explanation for the big difference in both crude case fatality rates (reported deaths as a share of confirmed cases) and estimated IFRs between New York and Florida. The current crude CFR for New York is nearly 8 percent, compared to 4.4 percent in Florida. Antibody tests suggest the IFR in New York is something like 0.6 percent, compared to 0.2 percent in the Miami area. Given Florida's high percentage of retirees, it was reasonable to expect that the state would see relatively high COVID-19 fatality rates. But Florida's policy of separating elderly people with COVID-19 from other vulnerable people they might otherwise have infected seems to have saved many lives. New York, by contrast, had a policy of returning COVID-19 patients to nursing homes.

"Massive deaths of elderly individuals in nursing homes, nosocomial infections [contracted in hospitals], and overwhelmed hospitals may…explain the very high fatality seen in specific locations in Northern Italy and in New York and New Jersey," Ioannidis says. "A very unfortunate decision of the governors in New York and New Jersey was to have COVID-19 patients sent to nursing homes. Moreover,
some hospitals in New York City hotspots reached maximum capacity and perhaps could not offer optimal care. With large proportions of medical and paramedical personnel infected, it is possible that nosocomial infections increased the death toll."

Ioannidis also notes that "New York City has an extremely busy, congested public transport system that may have exposed large segments of the population to high infectious load in close contact transmission and, thus, perhaps more severe disease." More speculatively, he notes the possibility that New York happened to be hit by a "more aggressive" variety of the virus, a hypothesis that "needs further

If you focus on hard-hit areas such as New York and New Jersey, an IFR between 0.2 and 0.3 percent, as suggested by the CDC's current best estimate, seems improbably low. "While most of these numbers are reasonable, the mortality rates shade far too low," University of Washington biologist Carl Bergstrom told CNN. "Estimates of the numbers infected in places like NYC are way out of line with these estimates."

But the CDC's estimate looks more reasonable when compared to the results of antibody studies in Miami-Dade County, Santa Clara County, Los Angeles County, and Boise, Idaho—places that so far have had markedly different experiences with COVID-19. We need to consider the likelihood that these divergent results reflect not just methodological issues but actual differences in the epidemic's impact—differences that can help inform the policies for dealing with it.


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Saturday Morning Breakfast Cereal - Program


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That wasn't lazy drawings in the background - the sim just hadn't fully rendered them.

Today's News:
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Saturday Morning Breakfast Cereal - Death


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The interesting thing about the circle of life is that if you look at a tiny piece of it, it's just a line segment.

Today's News:
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May 23rd, 2020: A Dam Shame

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The failure of a Michigan Dam this week caused a huge lake to vanish. Suddenly people with lakeside properties planning for the Opening Weekend of the Season ... have swamp properties with a view of dead fish and stranded watercraft.

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Links 5/20


[Epistemic status: I haven’t independently verified each link. On average, commenters will end up spotting evidence that around two or three of the links in each links post are wrong or misleading. I correct these as I see them, but can’t guarantee I will have caught them all by the time you read this.]

The Movement For The Restoration Of The Ten Commandments Of God had such a strong emphasis on the Commandments that they “discouraged talking, for fear of breaking the Eigth Commandment [against bearing false witness], and on some days communication was only conducted in sign language.” Pretty impressive, although I feel like they might have departed from the Decalogue a tiny bit at the part where they murdered 530 people.

The 1960s were simpler times, when ads in kids’ magazines offered to sell you a pet monkey for $19.95. “My brother is 8, I am 9 years old…and we had $19.95 because we washed cars, we mowed lawns.” What could go wrong?

Gwern on hard to notice ways that things have improved during his lifetime (ie since the late 1980s). Some things are big technology, like the Internet and electric cars. Other things are tiny improvements in everyday objects, like self-adhesive stamps, power windows in cars, wheeled luggage, TVs you don’t have to adjust the antennae on, and computer mice you don’t have to remember to clean. Radios stopped being staticky, air travel got cheaper, showers don’t run out of hot water. Still others are vast vague improvements in whole areas of life, like cleaner air and water, or Amazon-style improved logistics. Recommended.

More sentimental cartography: a map of linguistics (h/t Copular Predicate)

In the 1500s, small forces of Europeans took over large chunks of the world, most famously Cortes and Pizarro in the Americans. But what about Portuguese conquerer Afonso de Albuquerque? In 1506 – just eight years after the first European ships rounded Africa and made it to the Indian ocean at all – he and the Portugese king made a plan to conquer enough Asian coastline to control trade on the Indian Ocean. Over the next seven years, they did exactly this, taking over choice ports like Hormuz (Iran), Goa (India), and Malacca (Malaysia). Unlike the Spanish conquistadors, who had the advantage of using guns while facing Stone Age empires, Afonso generally faced enemies as advanced (and sometimes more advanced) than himself. How did he do it? Daniel Kokotajlo on Less Wrong writes about the lessons from Afonso and the other conquistadors.

The McLibel Case – activists Helen Steel and David Morris distributed anti-McDonalds pamphlets in the UK. McDonalds sued them for libel, starting a case that would cast international attention on the UK’s unusually strict and freedom-of-speech-threatening libel laws. My favorite part of this article is about a proposed settlement: “Steel and Morris secretly recorded the meeting, in which McDonald’s said the pair could criticise McDonald’s privately to friends but must cease talking to the media or distributing leaflets. Steel and Morris wrote a letter in response saying they would agree to the terms if McDonald’s ceased advertising its products and instead only recommended the restaurant privately to friends.”

538 on which states have produced the most presidential nominees. Did you know eight nominees have come from the western US, and all of them were Republicans? Why should that be?

“At this point it’s been pretty conclusively established that the ocean is weird, but one of weirder marine phenomena I’ve encountered is the sea monk or sea bishop, an animal that was sighted of the coast of Poland in 1531, washed up on Danish shores in the late 1540s and went the 16th century equivalent of viral.” Even if you don’t read this one, at least look at the pictures!

Update: new meta-analysis out of Stanford reviews 35 studies and claims that Alcoholics Anonymous is the most effective path to abstinence, and “was nearly always found to be more effective than psychotherapy in achieving abstinence”. Read this in the context of my previous article Alcoholics Anonymous: Much More Than You Wanted To Know. Overall I am glad to have some evidence to use against the Internet people who always say “science has debunked Alcoholics Anonymous”, but I’m not convinced it’s the right solution for everyone, or necessarily better than any other equally-structured programs. I may have more to say when I’ve read the study in more detail.

This Twitter thread combines a discussion of Bay Area zoning policy with one of the best puns I have ever seen (the Bay won’t let someone rezone something, and this gets described as “an unrezonable decision”).

Marvel introduces two new social-justice-themed superheroes, Snowflake and Safespace (also, they’re black and nonbinary). The writer swears he is not making fun of anyone and actually thinks this is a good idea.

The burned house horizon is the area in Europe where people from 7000 BC to 2000 BC often deliberately burned their own houses down for no apparent reason. Contains modern Romania, Bulgaria, Ukraine, etc. The “Cucuteni-Trypillian culture” built the largest cities in history up to that date, then burned them down every 75 years or so, consistently, for centuries. “Whether the houses were set on fire in a ritualistic way all together before abandoning the settlement, or each house was destroyed at the end of its life (e.g. before building a new one) it is still a matter of debate…some scholars have theorized that the buildings were burned ritually, regularly and deliberately in order to mark the end of the “life” of the house. The terms ‘domicide’ and ‘domithanasia’ have been coined to refer to this practice.” Also, “although there have been some attempts to try to replicate the results of these ancient settlement burnings, no modern experiment has yet managed to successfully reproduce the conditions that would leave behind the type of evidence that is found in these burned Neolithic sites, had the structures burned under normal conditions”

This is several Weird Venezuelan Happenings ago now, but hopefully you didn’t miss the time last month when a Venezuelan warship attacked an unarmed cruise ship for unclear reasons, but managed to sink itself in the process instead. See also this mock Wikipedia infographic about the battle.

I stumbled across this 2012 Siddhartha Mukherjee piece on depression recently. Even though it’s eight years old, it does a better job than most modern pop science in navigating the successes and failures of SSRIs and the serotonin hypothesis of depression more generally.

Moore’s Law is pretty great, but “in many areas, performance gains due to improvements in algorithms have vastly exceeded even the dramatic performance gains due to increased processor speed”.

The late 1980s saw the “heterosexual AIDS panic”, where people started worrying AIDS would devastate the straight community to the same degree as the gay community. At its peak, Oprah told her audience that “research studies now project that one in five heterosexuals could be dead from AIDS at the end of the next three years”, and the Secretary of Health and Human Services claimed AIDS could be worse than the Black Death, which killed a third of Europeans. I came across this because Michael Fumento, who helped calm the panic and debunk the rumors, is back in the news saying coronavirus won’t be a big deal – which makes me worry he’s less a heroic lone voice of reason, and a more a guy who just really likes dismissing diseases.

Best of new Less Wrong: conflict theory vs. mistake theory as different strategies for general non-zero-sum games

The Taiwan Junket: an unimportant assemblyman in a backwater state legislature gets asked to propose a meaningless bill about Taiwan. When the meaningless bill passes because nobody cares enough to vote against it, he gets hailed as a hero in Taiwan and offered a free trip to the country to attend a dinner in his honor. He concludes that this was a Taiwanese government propaganda effort to dazzle citizens who aren’t paying attention to details.

Best of new Less Wrong: Choosing The Zero Point. If you frame vegetarianism as a moral obligation you’re shameful for failing at, people get angry and won’t do it. If you frame it as a surprising new opportunity to do more good than you expected to be able to do before, people get excited and are more interested. What’s the general case of this?

It’s always been true that for what the state spends on public-schooling your kid, you could hire fancy private tutors with tiny class sizes (for example, in New York you could buy a $100K/year tutor to teach five kids full-time). @webdevmason points out that this is even more relevant now that reopening public schools could help spread a deadly pandemic.

Silly rules improve the capacity of agents to learn stable enforcement and compliance behaviors claims that arbitrary rules (like eg Jewish ritual law) play a useful role by spreading information about which of your neighbors comply with taboos and how often violations get punished. They present a toy model that shows that rules against eating poisonous berries work better when coupled with an arbitrary pointless rule whose violation has no real consequences.

Many people including me have enjoyed reading comments by no_bear_so_low (aka De Pony Sum) on the SSC subreddit. Now he’s released an online collection of his essays.

Average national IQ correlates well with GDP per capita and other measures of development. But is average national IQ really the right number to look at? “Smart fraction theory” suggests we should instead look at the range of top IQs, since the smartest people are most likely to drive national growth by inventing things or starting businesses or governing well. Now Heiner Rindermann and James Thompson (names you may recognize!) have given the hypothesis its most complete test so far, and found that yes, IQ at the 95th percentile correlates better with national development than at the 50th percentile. But I am a little skeptical of their results, because 95th-%-IQ correlates at about 0.97 with 50th-%-IQ, so any signal from the difference would be very tiny and probably swamped by other features. Also, usually when 50th and 95th are really different, it’s because the country is multiracial (eg South Africa had the highest 50th-to-95th-percentile IQ difference in the whole sample) and those countries’ policies and economies depend a lot on unique features of exactly what’s going on racially. Some more commentary here.

Related: the above study shows Kazakhstan as having among the highest IQs in the world. This was surprising enough to me that I looked it up, and although they are middle-of-the-road by most measures, one study found they have an extraordinary number of super-high-achievers on standardized tests, beating out usual titans like Finland, Switzerland, Israel, and the US. They could be using the Chinese strategy (only let your smartest students take the test in order to look good). But also, the USSR also stuck its space program and several other science megaprojects in Kazakhstan, and a lot of the scientists stayed around after the USSR broke up, so maybe there are a lot of really bright Russian kids. Also, Stalin deported a lot of Koreans there for reasons that probably made sense to him at the time, and some of them are still around too. Also, they’ve resisted Western pressure to stop having a gifted program in their education system, which probably helps a lot. So who knows, maybe the numbers are right?

Stephen Wolfram: Finally We May Have A Path To The Fundamental Theory Of Physics, And It’s Beautiful vs. r/SSC commenters: Oh God, It’s Stephen Wolfram Talking About Cellular Automata Again. See also this Scientific American article, which leans towards the second position.

Best of new Less Wrong: Discontinuous Progress In History: An Update. The first nuke was thousands of times more powerful than any preceding bomb; a graph of bomb progress would have looked like a gently sloping line that suddenly shot up a cliff in 1945. How common is this pattern? Is progress along some metric (like bomb power, or ship speed, or…) usually linear, linear with occasional cliffs, or totally random? Katja Grace investigates. Be sure to check out the section on the Shipularity, where ship sizes briefly increased so quickly that a naive best-fit would have reached infinity in 1860, produced a single utterly huge ship (SS Great Eastern) in 1858, then crashed back down again and resumed growing normally. It concludes that trends are usually continuous except in certain unusual situations, such as “when Isambard Kingdom Brunel is somehow involved”. Of obvious relevance to AI singularities, since we’re wondering whether AI capabilities will grow at some constant rate or suddenly shoot up – someone should make sure no Brunel descendant gets a job at DeepMind.

Against exaggerated criticism of Dr. Seuss – no, he didn’t cheat on his wife when she had cancer, and he (probably) didn’t (exactly) drive her to suicide.

“The common assessment is that Cuba’s achievements in lowering infant mortality and increasing longevity are among the praiseworthy outcomes of the regime—a viewpoint reinforced by studies published in US medical journals…we argue that some of the praise is unjustified. Although Cuban health statistics appear strong, they overstate the achievements because of data manipulation.” And “data manipulation” includes things like “sometimes they force abortions on unconsenting mothers because the fetus looks sickly and if it dies after birth it will ruin their infant mortality stats”. See also discussion here. Cf. eg New York Times‘s treatment of the same topic – “Cuba has the Medicare For All that many Americans dream about…we should push for American babies born in low-income families to have the same to have the same opportunities for attentive health care as [Cuban babies] will have.” [EDIT: see comments here]

Stephan Guyenet on peer review: “I see a lot of harsh criticism of the scientific peer review process, and I think some of it is deserved. But as someone who has been conducting deep evaluations of published literature outside the peer review process, I’d like to offer some perspective…” When he reviews popular science books, he finds that they’re often egregiously wrong about basic facts and nobody has noticed, so he thinks peer review is necessary to enforce a minimum standard of honesty.

Reason presents a theory of how US health care got this way, and discusses the “doctor’s cooperatives” that were handling the job pretty well before the AMA regulated them out of existence.

Related: the New York Times asks health economics experts to rank different countries’ health care systems in a bracket-style tournament. Some big surprises – 4 out of 5 experts say the US’ system is better than Singapore’s! Switzerland is the overall winner.

According to polls, trust in experts (of all types) has increased significantly over the past twenty years. But experts keep telling me it’s been going down. Guess I’ll stop trusting them! But that means trust in experts is going down, which means I should have trusted them after all. Aaah, there’s no way out! Help! [EDIT: Only true for the UK]

New paper asks MTurk users and Intro Psych students to take a survey, and includes some text in the middle of a question meant to test whether they are really paying attention. It finds that 22% of Turkers (and 64% of students) weren’t reading the question before answering. Author: “I think MTurk workers are better respondents. All of the other evidence I’ve seen suggests that, too.”

Speaking of surveys, here’s the results from r/TheMotte’s. I am obviously interested in A Ranking Of Everything, From Scott Alexander To Stalin. Yes, I am the top-ranked person on the list and beat eg George Washington. You could sort of explain that by r/themotte being a spinoff from this blog and so heavily selected for people who like me. But note that other top ten responses are things like “I believe capitalism is a better economic system than all available alternatives” and various other controversial things – users are ranking controversial things they agree with higher than obviously good stuff (“Andrew Yang” is above “religious freedom”; “I believe a baker should be allowed to refuse to bake a cake for a gay wedding” is above “Abraham Lincoln”). Check out also the writeup of The Modal Motte User if you want to feel uncomfortably seen.

Related: r/TheMotte survey results on the MBTI test

Reporters Without Borders has built The Uncensored Library on Minecraft, containing all the information banned by the repressive governments of the world. The idea is that repressive-state-citizens behind firewalls that prevent them from accessing traditional websites with banned terms can still play Minecraft and get the information that way. Oh, and the architecture is beautiful, exactly what you’d want for a utopian worldwide library dedicated to freedom of thought built in a virtual world with no resource constraints. If we told 1990 we had something like this, they’d think the future had turned out okay after all.

Lesbians (inhabitants of the island of Lesbos) are suing lesbians (homosexual women) in Greek court for “appropriating their national identity”.

Some discussion (based on this and this study) demonstrating that rich Democratic donors do not drag their party toward the right on economic issues.

YouTube admits boosting mainstream media channels over individuals’ videos even though users watch less of them and it makes them lose money.

LA Times on the affordable housing crisis in California. The government regulates affordable housing so heavily that it’s more expensive to build affordable housing for poor people than luxury houses for rich people, and so affordable houses mostly just never get built.

Related: a story about how Mitt Romney solved a homeless shelter budget crisis in Massachusetts. The old policy was that homeless people would stay in a homeless shelter until it was full, and then anyone else who needed shelter would get put up in a hotel at government expense. But lots of people were getting put up at hotels at government expense and it was really expensive. Romney’s new policy was that if a shelter was full and a new person showed up, the longest-time resident of the shelter could go to the hotel, and the new person would stay at the homeless shelter. The rate of new people wanting to stay at full homeless shelters plummeted.

A newly-discovered microbe can “completely stop mosquitoes from being infected by malaria”, scientists already investigating whether it can be used to help eradicate the disease.

In the 1970s, the Japanese auto industry produced noticeably better cars than the US auto industry at lower prices. How did they manage it, and how come it took the US decades to catch up? This review is the best I’ve found on the subject, but although it has lots of great history I still don’t have a good feeling for exactly what the Japanese advantage was and why it was so hard for Americans to do even when the Japanese basically handed their US competitors all their procedures on a silver platter.

DrugsAnd.Me is an exceptionally good site on recreational drugs, when they are vs. aren’t dangerous, and how to use them safely if you decide to go that route. I find myself learning new things even on drugs I am supposedly competent to prescribe to people. Did you know some people think Asians might metabolize benzodiazepines unusually slowly and should start with half the usual dose?

The Scunthorpe Problem is when innocuous words trigger censorship or spam filters because they contain a suspect string – for example, the English town of Scunthorpe sometimes gets censored because it contains “cunt” (also the English town of Lightwater, because it contains “twat”). Some of these are really funny – apparently it’s hard to discuss socialism on some sites because the substring “cialis” makes the filter think it’s an erectile dysfunction ad.

John Alexander Dowie, legendary charlatan faith healer and messianic prophet, got several thousand of his followers to move to his new commune of Zion, Illinois, a town described as “”a carefully-devised large-scale platform for securities fraud”. He is most famous for getting into a Messiah-duel with contemporary Muslim Messiah-claimant Mirza Ghulam Ahmad, founder of the still-extant Ahmadiyya movement. Ahmad challenged Dowie to a contest where they would each pray to outlive the other; whoever survived longest was the real Messiah. Dowie died a year before Ahmad, so I guess the Muslims win this one. Also, check out his outfit. Stylish!

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Coronalinks 5/18/20: When All You Have Is A Hammer, Everything Starts Looking Like A Dance


It is the sixty-first day of shelter-in-place. Anti-lockdown protesters have stormed your state capitol, chanting Nazi, Communist, ISIS, and pro-Jeffrey Epstein slogans to help you figure out they’re the bad guys. Inside, the Governor has just finished announcing his 37 step plan to reopen the state over the next ten years. You kind of feel like he should be a little more proactive, but the protesters outside have just unfurled a Khmer Rouge flag, so you hold your tongue.

Meanwhile, a band of renegade economists, tech billionaires, and MIT professors has just announced a bold disruptive Manhattan-Project-style moonshot: send a team of researchers to the swamps of Florida, where legends speak of a Fountain of Youth whose water can cure any malady. But disaster strikes when Florida’s governor announces that exploration is not an essential activity, and threatens to release the quarantine enforcement lions. The nation looks to the White House to solve the growing conflict, but President Trump is too busy evangelizing his latest coronavirus cure: eating those little packets of silica gel in food that say DO NOT EAT. As the Western States Pact and the Eastern Bloc inch closer to war, all that the rest of us can do is strive to stay as well-informed as possible, trying to make sense out of an increasingly nonsensical situation. So:

“Jail Isn’t Real”, I Assure Myself As I Close My Eyes And Drive To The Hair Salon

Here are some CDC graphs that use cell phone data to measure percent of people leaving home over time (source, h/t Kelsey):

On this measure, official government stay-at-home orders didn’t seem to affect the percent of people staying at home, even the tiniest bit.

Facebook is tracking something similar – see their terrible and hard-to-use website here. Here are the data from California:

Can you tell what day a statewide lockdown order was issued? (click here and check the date of the article for answer).

If comparing times doesn’t impress you, we can also compare places. Sweden has attracted international attention for its refusal to shut down business – restaurants and bars there are open as usual. And Nashville has attracted attention as a center of growing anti-lockdown protests by people who think its shelter-in-place order is too strict. But cell phone data finds that citizens of Stockholm and Nashville “have nearly the exact same adjustment in driving, walking, and transit use”.

What’s going on here? On the one hand, lockdowns are poorly enforced and we’ve all seen pictures of people going to the beach unmolested. On the other hand, surely fewer people are going to work, since the offices are all closed? Surely fewer people are going shopping, since the malls are all closed? What about all those pictures of empty freeways during rush hour?

The best answer I can come up with is that most people are risk-averse and started staying at home before the official lockdown. A few risk-tolerant people didn’t, but they are disobeying the lockdown as much as they can anyway. And the cases where risk-tolerant people can’t disobey the lockdown aren’t numerous enough to show up in aggregated cell phone data.

I find this answer pretty unsatisfying, so maybe I’m just misunderstanding what the cell phone tracking data are trying to show, or how much I should expect from them. This might also be a good time to review the ongoing debate about whether reality drives straight lines on graphs, or straight lines on graphs drive reality.


Our World In Data deserves some kind of prize. I think they already have won some prizes, but they deserve better ones. Possibly a Nobel, or a knighthood, or beatification. They give you any information you want, from any country you want, and display it however you want. If you’re trying to figure things out about the coronavirus and not using Our World In Data’s tools and graphs, you’re missing out.

Here’s coronavirus cases per capita across countries, by days after the number of cases per capita in that country passed one in a million. There’s some debate over what we gain/lose by adjusting/not-adjusting for per capita, but I think this is probably the best measure of how good a job different countries are doing at containing the infection:

And here’s coronavirus deaths, by the same measure:

And to save you the trouble of having to divide the first graph by the second graph, case fatality rates:

And since all of these numbers are confounded by testing rates, here’s tests per thousand people:

You’ll hear a lot of bad takes about where America ranks relative to other countries. Ignore them and look at these four graphs. America has one of the highest infection rates of any developed country, trailing only Spain. But it has one of the lowest mortality rates of any developed country, beaten only by Germany, Denmark, and a few other of the usual high performers. It’s right in the middle in terms of numbers of tests, beating eg Netherlands and Sweden, but trailing Germany and Denmark (though it may have an “advantage” on testing since so many people are infected).

Why is US mortality rate so low? The rate could be artificially low it we were unusually good at testing, but we aren’t. It might mean our health care system is unusually good, but that doesn’t seem like us either. I haven’t heard anyone claim that our standards for reporting a death as COVID-19 are stricter than anyone else’s, and our uncategorized excess mortality doesn’t seem much different from everyone else’s. I notice that all highest-mortality-rate countries are European, and that less-developed countries tend to be lower. Maybe it’s something about density? Maybe Europe got a different strain of the virus than everyone else? I only see a few people talking about this (Kevin Drum continues his 100% success rate of having gotten to interesting topics before I did, but see aso here and here), but nobody seems to have much in the way of a theory.

[edit: bpodgursky points out that European populations are, on average, much older than the US]

How effective has lockdown been at controlling the spread of the virus? Three countries have made the news for unusually weak/nonexistent lockdowns – Sweden, the Netherlands, and Japan. All have chosen to keep most of their economy open in the name of “herd immunity”, although they’ve banned very large gatherings like concerts and sports games. If we accept Denmark, Germany, and South Korea as “matched controls” that have made more aggressive lockdown efforts, it’s hard to see much of a difference. Sweden’s doing worse than Denmark, but not as much worse as we might have expected. Netherlands is marginally worse than Germany, and Japan marginally worse than South Korea – but it all seems within chance variation. If we’d chosen to use Belgium as a control for the Netherlands (I didn’t because it’s recording mortality statistics in an odd way), Belgium would have looked worse. Countries like Spain and the UK which responded pretty aggressively have more cases than a lot of countries that are barely doing anything at all.

This seems to match the conclusion from the last section: government policy isn’t mattering as much as we think. We thought South Korea and Taiwan were doing well because their governments were so brilliant and competent, but Japan’s government kept denying the problem existed in order to preserve their shot at holding the Olympics, and they seem to be doing equally well.

Switzerland is another weird case. It’s a loose confederation of linguistically French, Germany, and Italian regions. Remember that France and Italy have been devastated by the virus, and Germany has mostly gotten off unscathed. The same is true of Swiss regions; French- and Italian-speaking cantons have been devastated, while their German-speaking neighbors wonder what all the fuss is about. The Swiss government swears that this has nothing to do with policy. From the linked article:

Talking to Swiss media outlet Le Temps on Thursday, the Federal Office of Public Health (FOPH) said the efforts to combat the virus were largely uniform across Switzerland – meaning other situational factors were at play.

The measures were decided at a federal level when the epidemic was already advanced in different ways in different regions,” a FOPH spokesperson said. “This has nothing to do with a difference in the extent to which different cantons have taken action.

This isn’t to say government policy doesn’t matter – just that it adds or subtracts a relatively small modifier on top of a much wider variation.

What’s going on? Various hypotheses – BCG vaccinations, smoking rates, genetics, different viral strains – have come and gone, mostly unconvincingly. Another hypothesis – time – does a little better. Countries with different levels of connection to Wuhan and different luck in terms of superspreader events had their epidemics start a month or two earlier or later. Later countries had the benefit of warmer weather and a more aware population who were already taking social distancing measures on their own regardless of what the government told them (national education level might play into this too). Then lockdown strength added a little more or less on top of this.

This explains a little. But it doesn’t explain NYC vs. the rest of the US, or Japan vs. the rest of the world. Something’s still missing here.


It’s becoming increasingly clear that a big (maybe the biggest) risk factor for coronavirus transmission is speaking. Singing is even worse. The louder you speak or sing, the worse it gets.

Some confirmed early superspreader events were choirs. A lot of others were churches, where everyone gets together and sings hymns full-blast. This person’s explanation for the surprisingly low rate of subway-mediated transmission in Japan is that nobody talks on a Japanese subway.

All this makes sense. Coronavirus has mostly droplet transmission. There are three ways to get droplets: coughing, sneezing, or talking/singing. You do one of those about a thousand times more often than either of the others.

I appreciate how much pressure there is on governors to open up churches, but they should be very careful about this, unless churchgoers can promise to stay uncharacteristically silent. I realize how bad it will look to say that golfing and rock concerts and orgies are allowed but churches aren’t. Still, governors should swallow their pride and stand firm.

(Or they could just troll people. I understand Muslims pray quietly facing the ground, so how about ordering that mosques are allowed to reopen but churches aren’t? Then sit back and watch the fireworks.)

An extremely crackpot theory – could the missing cultural vulnerability factor be how loud and spittle-filled people’s speech is? When I think of a country where people talk very loudly to each other without much personal space, Italy is on the top of my list. Then comes New York City, which muscles its way in even though it isn’t even a country. When I think of countries where everyone talks really quietly and far away from each other, I think of Japan, South Korea, and all those other Asian countries that have mysteriously escaped infection.

Are there counterexamples? I Googled “loudest cultures”, and got people talking about Australians, Africans, and Cantonese Chinese. All those places have done pretty well – though they’re all pretty warm right now, which is a confounding factor. Without being able to find some kind of official data about conversational volume, I’m not sure there’s much I can do with this hypothesis right now.

[EDIT: Commenters point to Georgians and Germans as people who speak loudly yet have avoided coronavirus epidemics]

Love In The Time Of Coronavirus

One of my housemates lives two blocks away from her boyfriend, and hasn’t hugged him in three months. A friend lives a town over from his parents, and hasn’t been able to visit them since March.

Meanwhile, government offices and the media are all talking about how to get hair salons to reopen as quickly as possible, and making detailed lists about what kind of golf courses are or aren’t okay. The governor of California has a four phase plan that discusses exactly what criteria need to be fulfilled before we can have fitness centers, swimming pools, and rock concerts – but not a word about when you can hug your loved ones.

Probably the government just assumes everyone is already breaking those rules and there’s no point in worrying about them. I think this assumption generally holds. My patients are mostly law-abiding upper-class liberals who think of the lockdown protesters in Michigan as basically death cultists – and almost all of them casually let slip that they’ve gone over to their parents’ for dinner, or visited their partner, or even had small gatherings with close friends. The cell phone tracking data is equally pessimistic about the lockdowns reaching too far into the private sphere.

But some people are genuinely law-abiding. Fewer all the time, now that they’ve spent months shut off from everyone they love, while watching everyone else go to the beach with their buddies and face zero repercussions. But the government should acknowledge that these people exist and try to support them. Give the slightest acknowledgment that in between declaring marijuana dispensaries an essential activity and saying that even though nobody else is allowed to work Elon Musk can reopen his Tesla factory because he’s famous, they should also have a plan for when you can see a friend again. Even something like “once we reach Phase 2 of the reopening, you may visit one person outside your household per week” would ease a lot of people’s misery. Even if this isn’t the best idea from a epidemiological standpoint, they should do it anyway, because otherwise people will visit people outside their household and lose all respect for the law in general.

Information Wet Markets

At last, coronavirus prediction markets have arrived. Check out CoronaInformationMarkets.com and start investing, unless you live in the United States which is an authoritarian Nazi communist Luddite hellhole and bans you from contributing. Some highlights:

“What percent of the global population will be estimated to have contracted COVID-19 by the end of 2020?” – LESS THAN ONE PERCENT is at 11%, BETWEEN ONE AND THREE PERCENT at 18%, BETWEEN THREE AND FIVE at 39%, and GREATER THAN FIVE at 32%.

“Will hydroxychloroquine be approved as a treatment for COVID-19 by the FDA by October 1 2020?” – YES has 32%, NO has 68%.

And “Will a vaccine be approved before the end of 2020” – almost exactly split, 48% YES, 52% NO.

If you’re too chicken to bet real money, or you live in a fascist antiintellectual statist kakistocracy like the US, you can go to Metaculus, which continues their great work soliciting and aggregating predictions made with fake Internet points.

“When will a SARS-CoV-2 vaccine candidate that has demonstrated an efficacy rate ≥75% in a n≥500 RCT be administered to 10M people?” – median guess, October 10, 2021

“When will the Dow Jones set a new all-time record high after the coronavirus crash of February 2020?” – median guess, December 24, 2021.

“When will Disneyland reopen?” – median guess, August 29, 2020

“Will it be reported that Donald Trump tested positive for COVID-19 in 2020?” – median guess, 25%

There’s also a section on the total number of worldwide coronavirus cases in each quarter of 2020. Q1 (January 1 to April 1) saw about a million worldwide. Today we’re at 4.6 million. Metaculus thinks that by July 1, we’ll be at 7.5 million. By October 1, 9.8 million. By year’s end, 10.9 million. Except that I got those by adding results from different quarters together, and an alternative question that just asks that directly gets 16.2 million. Come on, people! Do some arbitrage! It’s almost like you’re not sufficiently devoted to winning fake Internet points!

Wash Your Hands!

Weird Sun Twitter does handwashing timing mnemonics:

When All You Have Is A Hammer, Everything Starts Looking Like A Dance

Everyone is hoping for a definitive solution to coronavirus. A vaccine, or a good antiviral, or a test + trace regimen so well-coordinated that it stops the virus in its tracks.

Suppose that after X years, we realize there is no definitive solution. We are faced with the choice of continuing restrictions forever, or lifting the restrictions, letting lots of people die, and getting herd immunity the hard way. What then?

If we lift the restrictions, the same number of people will die as if we had never instituted any restrictions at all, and also we will have wasted X years. We will have gone X years with millions of people poor and unemployed, millions of others locked in their houses and unable to have fun – and it won’t have saved a single life.

If there’s a 50% chance of a definitive solution in one year, is it worth staying locked down until then? What about a 25% chance in five years? 10% chance in ten years? If there is never a definitive solution, are we willing to stay locked down forever?

Also: if a lockdown lasts a long time, what’s the average R0 during that phase? One possibility is that it’s less than 1, in which case the virus will “die out” locally (although it probably won’t go extinct smallpox-style – too much opportunity for other countries to reinfect us). Another possibility is that it’s more than 1, in which case lockdown isn’t working and we get continued exponential growth ending in lots of deaths and eventual herd immunity.

Is there a possibility where R0 is exactly 1? Seems unlikely – one is a pretty specific number. On the other hand, it’s been weirdly close to one in the US, and worldwide, for the past month or two. You could imagine an unfortunate control system, where every time the case count goes down, people stop worrying and go out and have fun, and every time the case count goes up, people freak out and stay indoors, and overall the new case count always hovers at the same rate. I’ve never heard of this happening, but this is a novel situation.

If that were true, right now we’re on track to gain herd immunity in 30 years. This would be another worst-of-all-worlds scenario where we have all the negatives of a long lockdown, but everyone gets infected anyway.

Sing, O Muse, Of Arbit-Rage

There’s a morbid joke about the news, which goes something like:

10,000 Africans in a famine =
1,000 Chinese in an earthquake =
100 Europeans in a plane crash =
10 Americans in a terrorist attack =
1 pretty white girl getting kidnapped

(if you want to go a different direction, you can add “= 0.1 black people murdered by cops”)

Coronavirus has killed about 100,000 Americans so far. How bad is that compared to other things?

Well, on the one hand, it’s about 15% as many Americans as die from heart attacks each year. If 15% more people died from heart attacks in the US next year, that would suck, but most people wouldn’t care that much. If some scientist has a plan to make heart attacks 15% less deadly, then sure, fund the scientist, but you probably wouldn’t want to shut down the entire US economy to fund them. It would just be a marginally good thing.

On the other hand, it’s also about the same number of Americans who died in the Vietnam War plus the Korean War plus 9/11 plus every school shooting ever. How much effort would you exert to prevent the Vietnam War plus the Korean War plus 9/11 plus every school shooting ever? Probably quite a lot!

Maybe part of this is that heart attack victims are generally (though not always!) older than 9/11 victims, so the cost in DALYs is lower. But the bigger problem is that there’s no arbitrage in the market for lives. Some normal good, like Toyota Camrys, sells for about the same price everywhere. There might be minor variations based on how far you go from a Toyota factory or something, but overall you wouldn’t expect the same Camry to sell for ten times as much in one city as another. Someone would arbitrage – buy the Toyotas in the cheap city and sell them in the expensive one! But the same reasoning fails when it applies to lives. Life has no single value denominated in dollars, attention, or outrage. So when we search for metaphors to tell us how bad 100,000 deaths from coronavirus are, our conclusion depends entirely on what metaphor we use. “It’s like 15% of heart attacks” sounds not-so-bad, and “it starts with the Vietnam War and gets worse from there” sounds awful, even though they’re the same number. There’s no way to fix this without somehow making all our intuitions collide against each other and equalize, which sounds really hard.

Suppose you reopened the economy tomorrow. You tried as hard as you could to put profits above people, squeezed every extra dollar out of the world regardless of human cost. And then you put a 1% tax on all that economic activity, and donated it to effective charity. Would that save more people than a strict lockdown? If a lockdown costs $5 trillion, then the 1% tax would make $50 billion. That’s about how much the Gates Foundation has spent, and they’ve saved about ten million lives. Ten million is higher than anyone expects US coronavirus deaths to be, so as far as I can tell this is a good deal.

On the other hand, the US spent about $5 trillion on the Iraq and Afghan wars. Even optimistically assuming this helped prevent some terrorism, it’s a no-brainer to say we should have accepted the cost in terrorist attacks and spent it on stricter COVID lockdowns instead.

Is spending resources on the coronavirus lockdown a good idea? A good idea compared to what? Compared to using resources efficiently, goodness no, not at all. Compared to putting the resources in a giant pile and setting them on fire, yes, definitely. Compared to usual practice? Usual practice basically involves alternating betwen the two previous options inconsistently; the answer depends on how long we spend in each category. At this point, we are too incompetent for questions about our preferences to even make sense.


The Marginal Revolution folks and the Mercatus Center are doing really amazing work to try to use economics to coordinate the pandemic response. Here’s a report by Caleb Watney and Alec Stapp about how the government should use purchase guarantees to boost production of essential medical equipment.

Patrick McKenzie of Kalzumeus, a Westerner in Japan, talks about his work trying to get them to realize the severity of the virus and take some response. Written on April 21, when Japan’s cases suddenly jumped and it seemed like he had presciently ferreted out an undercover epidemic. Since then, Japan has gone back to mysteriously defying gravity, so I’m not sure how to think about this now.

Mark Andreessen made waves with an article arguing that the coronavirus shows America needs to learn how to build things again. I also appreciated Ezra Klein’s response, which was that America already knows how to build things but is blocked by government dysfunction (I doubt Andreesen disagrees with this framing). Klein highlights the term “vetocracy” for all the features of modern society which give us a bias against inaction. Clearly true and important, although a fuller treatment (which I hope to give!) would have to talk about the advantages vs. disadvantages of bias for action vs. inaction (the very end of this post can perhaps be interpreted as a paean to vetocracy). See also Mark Lutter: Build Institutions, Not Apps.

Related to the bat discussion from last post – a new paper finds that viral zoonotic risk is homogenous among taxonomic orders of mammalian and avian hosts – in other words, despite how it looks, bats don’t spread disproportionately more viruses to humans than any other animal – there are just a lot of bats. But see also this contradictory past study.

Earlier I asked whether some savvy early coronavirus investors had dealt a blow to the efficient market hypothesis. Now that the dust has cleared, I agree with this post saying the EMH still looks pretty good – although sometimes it moves in mysterious ways. Also in me-being-wrong news, evidence continues to come in about whether smoking is a risk factor for coronavirus, protective against it, or all the studies are biased and we have no idea. Something in this space will probably end up on my Mistakes page one day, but I’m going to wait until I can be absolutely sure I know what.

Everyone expected prisons and homeless shelters to be devastated by coronavirus, since they had lots of people together in close quarters and little ability to escape. Although these institutions have not had great times, they seem to have weathered the storm better than a lot of people would have predicted, mostly due to a high rate of asymptomatic infections. Why?

There was a lot of talk a few weeks about about Eastern European success at avoiding the coronavirus. Then Russia and Belarus’ case numbers exploded; both are now doing as bad as any Western European country. Poland, Romania, Czechia, and others continue to be oddly quiet. I suspect random variation – Russia and Belarus looked good until they weren’t – but I guess we’ll find out soon.

This article is kind of critical of Dominic Cummings, but the criticism is that he inappropriately pressured scientific bodies to order a UK lockdown ASAP, instead of letting the scientists take however long it took to evaluate the evidence in a proper scientific way. I like due process and checks-and-balances as much as the next liberal, but I also think you should be allowed to break the rules in an emergency and then let the people affected by your choice decide whether they want to show you mercy based on time proving you right, or punish you to the full extent of the law based on time proving you wrong. In this case he was right and deserves to be celebrated.

Some studies of remdesevir, not very encouraging. Hydroxychloroquine is basically dead in the water at this point, sorry Donald.

Some people are worried that coronavirus might be overblown and doctors are just classifying random other stuff as coronavirus deaths. The best antidote to this claim is this look at excess mortality over the average for this time of year worldwide.

You’ve probably already read this, but the story about how Trump’s premature praise for hydroxychloroquine caused some supporters to overdose on hydroxychloroquine-containing fishtank cleaner got a lot more complicated – they were actually both anti-Trump Democrats, and the woman is now under investigation for murdering her husband and inventing the hydroxychloroquine story to cover it up. This seems like one of those things which is probably a metaphor for life.

There’s been some worry about coronavirus reinfection – maybe people who have already gotten it aren’t immune and can get it again? A recent Korean study tried to put those fears to rest, showing that they were mostly testing errors. Professor Shane Crotty says he has studied the immunology of coronavirus and come to the same conclusion a- after infection, the immune system is able to create antibodies to it which prevent further infection for a while. Two data points don’t prove anything, but this is how things work with most viruses, so the burden of proof is on anyone who thinks COVID-19 is different.

Are coronavirus victims so old and sick they would just die from something else soon anyway? Two studies were recently reported as saying they would have lived at least ten more years, but read Scoop dissecting them in the comments section here.

A few weeks ago people were talking about the “iceberg hypothesis” – maybe detected coronavirus cases are “just the tip of the iceberg”, and there have been so many asymptomatic people that we’re nearing herd immunity already. Recent studies haven’t been kind to this proposal. Both France and Spain have about 5% seroprevalence, which means official counts are only off by a factor of ten, about what we already expected. It also means true mortality rate is still about 1%, also what we already expected (and high enough to result in tens of thousands of deaths before anyone gets herd immunity). No icebergs here. A Santa Clara study seemed to show 2% seroprevalence, which actually was much higher than expected and would be consistent with the iceberg theory, but Andrew Gelman is very much not impressed. Greg Cochran gives the hypothesis a postmortem here, and also is not impressed with claims that we might be able to naturally and easily achieve herd immunity before about ~70% of people are infected.

Elon Musk has reopened Tesla’s Bay Area factory. Although the rest of California is gradually reopening, the Bay Area is playing it extra careful and has asked everyone to stay home until at least June 1. Except, apparently, Elon Musk, who declared the factory was reopening regardless of what anyone said, and that “if anyone is arrested I ask only that it be me”. For some reason, the county did not arrest him, and now it seems to have retroactively legitimized Musk’s action. I like Elon Musk and I support the right to civil disobedience, but the government should absolutely have arrested him. They wouldn’t necessarily have to give him twenty years to life or anything, just arrest him enough to make it clear that there are laws and you get punished if you break them. [EDIT: see here for discussion of why he wasn’t arrested]

Nate Silver crunches the evidence and finds that (contra what I wrote last time) there is no evidence that voting by mail gives one party an advantage. So how come Democrats are so excited about it and Republicans so anxious to prevent it? Do they know something Silver doesn’t know? Or are they really and truly just concerned about their principles, with no ulterior motive?

The latest from EA on best ways to donate to the fight against coronavirus. Summary of the summary: Fast Grants and Development Media International. Fast Grants has a minimum donation of $10,000 (they are smart people and I assume there is a reason for this); some people were previously trying to pool their donations to reach this amount but I don’t know where the latest active pools are.

Coronavirus has killed 90,000 Americans so far. Donald Trump tried to put this in context by saying the seasonal flu sometimes kills 60,000 people a year. There are a lot of problems with this comparison, but one I didn’t realize is that coronavirus death toll only counts confirmed cases, whereas flu death toll counts estimated cases, ie a guess as to how many cases we would find if we had perfection detection. The number of confirmed flu deaths – a fair comparison to the 90,000 confirmed coronavirus deaths – is about 10,000 yearly. The article also is not convinced that the 60,000 flu death statistic is a fair attempt at estimating reality as opposed to a made up number that signals how much the CDC wants us to worry about the flu, and it suggests the CDC officially lower the flu death toll in order to signal that we want people to worry less about it compared to coronavirus (how many simulacrum levels are you on? You are like a little baby, watch this…)

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9 days ago
Lafayette, LA, USA
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